title: Acute kidney injury in critically ill patients with 2009 influenza A (H1N1) viral pneumonia: an observational study.
abstract: OBJECTIVE
  To describe the incidence, risk factors, and impact on mortality of acute kidney injury (AKI) in patients with 2009 influenza A (H1N1) viral pneumonia requiring mechanical ventilation.
  
  
  METHODS
  Observational cohort study.
  
  
  METHODS
  AKI was defined as risk, injury or failure, according to the RIFLE classification. Early and late AKI were defined as AKI occurring on intensive care unit (ICU) day 2 or before, or after ICU day 2, respectively. Demographic data and information on organ dysfunction were collected daily.
  
  
  RESULTS
  Of 84 patients, AKI developed in 43 patients (51%). Twenty (24%) needed renal replacement therapy. Early and late AKI were found in 28 (33%) and 15 (18%) patients, respectively. Patients with AKI, as compared with patients without AKI, had higher Acute Physiology and Chronic Health Evaluation (APACHE) II score and ICU mortality (72% versus 39%, p < 0.01) and presented on admission more marked cardiovascular, respiratory, and hematological dysfunction. Patients with early but not late AKI presented on admission higher APACHE II score and more marked organ dysfunction, as compared with patients without AKI. ICU mortality was higher in late versus early AKI (93% versus 61%, p < 0.001). On multivariate analysis, only APACHE II score and late but not early AKI [odds ratio (OR) 1.1 (95% confidence interval 1.0-1.1) and 15.1 (1.8-130.7), respectively] were associated with mortality.
  
  
  CONCLUSIONS
  AKI is a frequent complication of 2009 influenza A (H1N1) viral pneumonia. AKI developing after 2 days in ICU appears to be associated with different risk factors than early AKI, and is related to a higher mortality rate.
authors.affiliation: Intensive Care Department, Hospital Universitario de Getafe, Getafe, Madrid, Spain.
authors.forename: N
authors.initials: N
authors.lastname: Nin
authors.forename: J A
authors.initials: JA
authors.lastname: Lorente
authors.forename: L
authors.initials: L
authors.lastname: Soto
authors.forename: F
authors.initials: F
authors.lastname: Ríos
authors.forename: J
authors.initials: J
authors.lastname: Hurtado
authors.forename: F
authors.initials: F
authors.lastname: Arancibia
authors.forename: S
authors.initials: S
authors.lastname: Ugarte
authors.forename: E
authors.initials: E
authors.lastname: Echevarría
authors.forename: P
authors.initials: P
authors.lastname: Cardinal
authors.forename: F
authors.initials: F
authors.lastname: Saldarini
authors.forename: H
authors.initials: H
authors.lastname: Bagnulo
authors.forename: I
authors.initials: I
authors.lastname: Cortés
authors.forename: G
authors.initials: G
authors.lastname: Bujedo
authors.forename: C
authors.initials: C
authors.lastname: Ortega
authors.forename: F
authors.initials: F
authors.lastname: Frutos
authors.forename: A
authors.initials: A
authors.lastname: Esteban
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology / Q000209:etiology / Q000401:mortality; D000328:Adult; D015331:Cohort Studies; D016638:Critical Illness; D005260:Female; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000150:complications* / Q000821:virology; D007362:Intensive Care Units; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D018570:Risk Assessment; D012307:Risk Factors; D013020:South America / Q000453:epidemiology